Talk about dangerous liaisons! Abnormal brain vascular connections like a dural arteriovenous fistula (dural AVF) can be dangerous! This month’s AJNR SCANtastic is here to you some durable knowledge about dural AVFs! Dural sinuses sit inside dural leaflets and arteries that feed the dura also feed the walls of... sinuses, like vasa vasorum. Arteries in the walls of veins are a natural connection between veins & arteries. Whether these are open depends on pressure. Normal venous pressure is not enough to open these connections, but if venous pressure is increased from thrombosis that pushes open these normal AVFs in the wall Now if fistula flow goes w/sinus flow, effect is relatively benign because dural venous sinuses are big & can handle extra flow. But if flow gets pushed backwards into cortical veins, flow is too much for cortical veins to handle & they are more likely to bleed. Presence of cortical reflux is dividing line if a fistula will have benign course or is likely to bleed Cognard classification defines dAVFs by the type of venous drainage. But you don’t have to memorize it. Just ask yourself: Can the venous outflow handle the flow (dural sinus vs cortical vein) & does it look like it is overwhelmed (venous ectasia)? In this month’s @the_AJNR, Itskeson et al. found 1/2 of dAVF pts had cognitive impairment. While more common w/cortical reflux, even pts w/o reflux had cognitive impairment that improved w/treatment This begs the question if there is any truly “benign” dAVF. Previously indications for treatment were venous reflux or debilitating pulsatile tinnitus. Perhaps we should be screening all dAVF patients for cognitive impairment and perhaps someday cognitive function will get incorporated into treatment decisions. Now you know the pathology of dural AVFs! Hopefully it stays w/you for the duration! But this only scratches the surface. Follow AJNR & check out the article for yourself:show more

Lea Alhilali, MD

79,624 subscribers

Teilen Herunterladen